Enteral nutrition: types, definition and uses with patients

This type of artificial feeding is one of the most commonly used with patients in hospitals.

In our daily life we are ingesting food continuously, several times a dayseveral times a day, most of the time without thinking about the complex process that we carry out both at the behavioral level.

But sometimes it is not possible to feed ourselves voluntarily: let's imagine that we are in a coma or that we suffer from some kind of disease that prevents us from eating. If nothing is done, the organism will eventually die of starvation.

Fortunately, we have mechanisms that allow us to continue to maintain an artificial supply of nutrients: enteral nutrition.

Enteral nutrition: what is it?

Enteral nutrition is, together with parenteral nutrition, one of the two types of artificial nutrition available in medicine. It is a support technique in which the different nutrients that the patient may need are introduced into the body, generally using a tube that is directed directly into the intestine or stomach.

This technique avoids the need for the food to pass through the mouth and the trachea, no voluntary movements are required to acquire the nutrients.. However, applying enteral nutrition requires the digestive system to be able to exercise its normal functions in absorbing the nutrients supplied.

Enteral nutrition helps to prevent, among other things, protein autocatabolism. (in other words, the body consumes itself to obtain nutrients), weakening of the immune system (with the consequent risk of infections), bacterial translocation (bacteria in the digestive tract itself causing an infection) and atrophy of the digestive system. The administration can be continuous or discontinuous according to the patient's needs.

Types of enteral nutrition

There are different methods by which enteral nutrition can be carried out. One way to classify the different types of enteral nutrition is according to where the tube is placed. is according to where the tube is placed and how far it reaches.

1. Nasogastric Tube Enteral Nutrition

In this procedure a tube is placed that will enter through the nose and will travel to the stomach. and will go all the way down to the stomachwhere the nutrients will be supplied. This is usually the most common mechanism, unless there is a risk of pulmonary aspiration of bowel contents.

If the patient is conscious will be introduced through the nostrils and the patient will be asked to swallow saliva and the patient will be asked to swallow saliva in order to direct the tube towards the digestive tract and not towards the respiratory tract. However, the cooperation or consciousness of the subject is not necessary to place the tube.

2. Enteral nutrition by nasoenteral probe

The procedure is the same as the previous one, except for the fact that in this case the tube will be taken to the intestine.

3. Enterostomy

When feeding through a nasoenteric or nasogastric tube is not feasible, there is another procedure: enterostomy. there is another procedure: enterostomy. In this case a tube is not introduced through the usual routes, but is placed directly through the skin. More than a tube, it is a type of catheter. It is also used when the patient is expected to be unable to feed himself for more than four weeks. Three main techniques stand out among enterostomies.

Pharyngostomy

A tube is placed directly into the pharynx.

Gastrostomy

This procedure is based on the placement of a tube that reaches the stomach, but in this case through the skin..

Jejunostomy

Like gastrostomy, a tube is inserted through the skin until it reaches the target organ, in this case the area of the intestine called the jejunum..

What types of substances are introduced into the body?

Enteral feeding involves introducing certain nutritional substances into the body, varying these substances according to the patient's needs.. They will vary if, for example, the patient has renal or hepatic insufficiency, diabetes, or respiratory problems. They also depend on the developmental stage of the subject (for example, breast milk is used in infants). Among other things, the caloric and protein content is taken into account (it can be hyper, normo or hypocaloric/protein).

As for the form in which the nutrients are presented, in general we can find polymeric formulas (in which intact proteins are provided), peptide formulas (hydrolyzed proteins) or elemental formulas (directly in the form of amino acids). There are also special diets for patients with specific problems.

The most common formula is that of a polymeric, normocaloric and normoproteic diet, but as we have already said, the choice of a polymeric, normocaloric and normoproteic diet is not easy.but, as we have already said, the choice of components will depend on the patient and his needs.

In which cases is it applied?

Enteral nutrition is the technique of choice in all situations where the patient is malnourished or at risk of malnutrition due to inability or refusal to swallow voluntarily, due to injury, illness or mental disorder. In other words: it is used both in patients with no capacity to swallow, with a very diminished capacity or who refuse to do so despite having the functional capacity to do so.

However, in order to be able to apply it, it is necessary that the digestive system has a minimum of functionality when digesting and/or absorbing nutrients. It can be used in subjects of any age, from infants to the elderly.

It is essential in situations where the subject has no swallowing capacityIt is essential in situations where the subject has no swallowing capacity, such as coma, or in case of pharyngeal alterations that make swallowing impossible.

It is also useful in some diseases in which although the patient has the functional capacity to do so, he/she cannot ingest due to problems such as bronchodysplasia or heart disease. Or when ingestion is impossible because it causes reactions such as vomiting because it provokes reactions such as vomiting.. Another case occurs in situations where the body needs more nutrients than the subject, despite eating, is able to provide.

On the other hand, it is also is also recommended for premature babiesIt is also recommended for premature babies, in order to prevent different diseases. Finally, it is used in mental disorders such as anorexia, forcing nutrition in cases of severe underweight that can lead to death,

Contraindications and risks

Enteral nutrition is a very beneficial technique that allows supplying the body with the necessary food when it is unable to ingest on its own. However, in some cases this type of feeding may be contraindicated due to the existence of problems in the digestive tract itself.

The main contraindication is in the presence of obstructions, bleeding or perforations in the stomach or intestine. obstructions, bleeding or perforations in the stomach or intestine..

The use of enteral nutrition may also involve some risks. There may be obstructions or displacement of the tube or possible metabolic complications if adequate nutrition has not been administered. Vomiting and nausea may occur, as well as diarrhea and reflux. Although rare, pulmonary aspiration of Gastrointestinal tract contents is possible.